Abstract: SA-PO0052
When the Cure Becomes the Culprit: Catastrophic Cascade of Levofloxacin-Induced Acute Interstitial Nephritis and Suspected Stevens-Johnson Syndrome (SJS)
Session Information
- AKI: Novel Patient Populations and Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Kumar, Anand, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Bilal, Ali M, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Bai, Sadhna, LSU Health Shreveport, Shreveport, Louisiana, United States
- Bilal, Khadijah, Kelsey-Seybold Medical Group PLLC, Houston, Texas, United States
- Mauiyyedi, Shamila, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
- Linfante, Anthony, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction
Acute interstitial nephritis (AIN), often drug-induced, can be reversible but becomes complex when paired with severe skin reactions like SJS/TEN. We present a rare case of suspected Levofloxacin-induced AIN with overlapping SJS/TEN features, leading to multi-organ failure despite treatment.
Case Description
A 70-year-old woman with hypertension and hyperlipidemia was transferred due to worsening diffuse rash and AKI requiring CRRT. Two weeks earlier, she was treated for atypical pneumonia with Augmentin and Azithromycin, followed by Levofloxacin. Six days post-discharge, she returned with dyspnea, leg edema, and a morbilliform, erythematous rash with scaling on the cheeks, xerosis, and lip fissures. Labs showed Cr 7.59 mg/dL (baseline 0.8). UA revealed hematuria and pyuria. Nephrology suspected Levofloxacin-induced AIN; steroids and hemodialysis were started. Dermatology evaluated for SJS/TEN; biopsy showed lymphocytic infiltrates and apoptotic keratinocytes but was inconclusive. Despite increased steroids and added Doxycycline for possible superinfection, her rash worsened. Kidney biopsy confirmed acute interstitial nephritis and tubular injury. IVIG and later Infliximab were initiated due to continued decline. She required ICU care and CRRT. Despite aggressive treatment, her condition deteriorated. After discussion of goals of care, the patient passed away.
Discussion
This case highlights the complexity of managing drug-induced complications affecting both kidneys and skin. The patient developed oliguric AKI requiring dialysis and a diffuse erythematous rash, raising concern for a multisystem hypersensitivity reaction. Kidney biopsy confirmed acute tubulointerstitial nephritis and tubular injury, while skin biopsy was nonspecific, not clearly indicating SJS/TEN. The case underscores the need for early recognition of drug-induced AIN, awareness of the limitations of skin biopsy in SCAR diagnosis, and the importance of prompt drug withdrawal. It also calls for multidisciplinary care and further research on immunomodulatory therapies.